Job market paper
This paper evaluates the determinants of physician geographic and professional movement within North Carolina (NC) using a dynamic discrete choice model designed to analyze the behavior of individuals over time. I jointly model the initial specialty, activity, location, facility, and hours of direct patient care of all physicians in NC from 2003 to 2012 using a full information maximum likelihood estimation approach that allows for correlation of unobserved determinants. Using the parameter estimates from the dynamic model, I simulate several policy interventions aimed to attract and retain physicians in rural and underserved areas. I find that loan forgiveness policies are less effective at decreasing the probability of movement and increasing retention in the same rural county than an increase in the reimbursement rate. An increase in midlevel practitioners in rural counties decreases retention in the same rural area and increases the likelihood of a physician becoming inactive, while an increase in registered nurses in rural areas significantly increases physician retention in the same rural area.